Financial Assistance

BILLING AND COLLECTION POLICY
Please be aware that each time you receive services from us a separate account is created. It is possible to have several accounts open at the same time. If you provided us with insurance information, your insurance company will be billed as a service to you. Insurance is designed to reimburse the policyholder and is a contract between the policyholder and the insurance company. We will submit benefit claims to your insurance company if all required information and authorization is provided. You are responsible for deductibles, co-insurance, and any items not paid by insurance. You should contact your insurance company to determine your cost-sharing responsibilities, if any.

A claim will be submitted to your insurance based on information you provided during the registration process. This could be as soon as 3 days after your discharge or release from the hospital. You may request a copy of your bill by contacting the number on the front of this statement. Generally, we allow 30 days for insurance to pay their portion. In the event that your insurance company is slow to pay or for some reason disallows the claim, payment of the full account balance is expected from you. You can avoid future billing notices by calling your insurance company to expedite payment. Our collection process will include additional billing notices every 28 days, until the account balance is resolved or placed with a collection agency.

It is important for the hospital and the patient to work together to solve payment issues. If you have any questions please feel free to call our hospital Business Office Customer Service Department at the phone number provided on the front of this notice.

PHYSICIAN BILLING INFORMATION
During the care you received at our facility you may have received services from physicians or other medical providers, such as Anesthesiologists, CRNA's, Radiologists, Emergency Room Physicians, etc. You will receive separate bills from these physicians or medical providers. Should you have any questions concerning their bill, please contact them directly. A list of the physicians and medical providers who bill separately is also enclosed.

PAYMENT POLICY
Payment in full is required at the time of service from all patients who owe co-pays, coinsurance, have not met their deductible, or do not have insurance coverage. Balances after insurance payment are due upon receipt. Please submit your payment along with the top portion of this statement in the enclosed return envelope. You may pay on-line with debit/credit card or electronic check by visiting our website listed on the front of this notice. You may contact the hospital Business Office if you are unable to pay your balance in full. Staff is available to answer any questions as well as discuss our financial assistance program and payment options. Our patient liaison can be reached by calling the hospital.

Estimates for upcoming scheduled or future elective services can be provided upon request by the Hospital Patient Access or Scheduling departments.

FINANCIAL ASSISTANCE SUMMARY
Our Hospital is committed to meeting the healthcare needs of the communities we serve. Emergency medical care is provided to everyone, regardless of ability to pay or lack of insurance coverage.

Our Financial Assistance Policy and Uninsured Discount Policy are available for review online by visiting our website listed on the front of this notice. To apply for Financial Assistance, you may download, print and complete the application. Mail or bring the application, along with the required documents to the hospital. You will be notified of our decision within 30 days of receipt of the required information. Please be aware we will use your application to identify other available health insurance options you might be eligible for, such as: Medicaid coverage, disability coverage, victims of crime, COBRA, etc... Financial assistance will not be provided to those eligible for any program coverage.